aetna breast reduction requirements

2016;20(3):256-260. Reduction mammoplasty: Criteria for insurance coverage. cursor: pointer; The goals of the surgery are to relieve symptoms caused by heavy breasts, to create a natural, balanced appearance with normal location of the nipple and areola, to maintain the capacity for lactation and allow for future breast exams/mammograms with minimal scarring or decreased sensation. Breast Reconstructive Surgery - Medical Clinical Policy Bulletins - Aetna It is universally believed by patients that if a surgery is considered reconstructive, it is medically indicated and covered by health insurance. Abnormalities in Adolescent Breast Development. In these cases, breast reduction for men may take 2 to 3 hours. The risks included infection, wound breakdown, scarring, and the need for re-operating. For many patients the psychological impact of the disease is substantial. of . text-decoration: underline; Three review authors undertook independent screening of the search results. The study by Schnur et al was based on a survey of 92 plastic surgeons who reported on their care for 591 patients. Kinell I, Baeusang-Linder M, Ohlsen L. The effect on the preoperative symptoms and the late results of Skoog's reduction mammoplasty: A follow-up study on 149 patients. Kerrigan CL, Collins ED, Kim HM, et al. 2001;76(5):503-510. They have argued that removal of even a few hundred grams of breast tissue can result in substantial pain relief. Grade III: Moderate breast enlargement exceeding areola boundaries with edges that are indistinct from the chest with skin redundancy present. 2019;8(4):431-440. Reduction mammaplasty. Study subjects included 3538 patients with an average age of 43 years and body mass index of 31.6 kg/m(2) and most patients underwent outpatient surgery (80.5%) with an average operative time of 180 minutes.The incidence of overall surgical complications was 5.1% and the incidence of major surgical complications was 2.1%. Determinants of surgical site infection after breast surgery. After these researchers 1st report of pectoral etching in 2012, patients and surgeons became more aware regarding gynecomastia resection when performing pectoral enhancement. This study included 35 patients who underwent breast reduction due to the idiopathic form of gynecomastia. Data was then analyzed for surgical complications, wound complications, and medical complications within 30 days of surgery on 4545 patients. The authors specified the value of these study results was in the identification of morbid obesity as a significant predictor of overall morbidity and active smoking as a strong predictor of major surgical morbidity. Srinivasaiahet al (2014) stated that although reduction mammoplasty has been shown to benefit physical, physiological, and psycho-social health there are recognized complications. Redundant skin was observed in 1 patient at 1 month post-operatively, whose breast, defined as grade-III, was the largest before operation. Breast reduction surgery (also called reduction mammaplasty) is a type of invasive procedure that involves incisions (cuts) in your skin to decrease the size and weight of your breasts . Often times, insurance company will dictate how much breast tissue to be removed. Inclusion criteria were as follows: men diagnosed with gynecomastia and BMI of less than or equal to 32 kg/m2, adequate skin elasticity, and general good health. .headerBar { 2009;7(2):114-119. Reduction mammoplasty has also been used for relief of pain in the back, neck and shoulders. Breast reduction, also known as reduction mammaplasty, is a procedure to remove excess breast fat, glandular tissue and skin to achieve a breast size more in proportion with your body and to alleviate the discomfort associated with excessively large breasts (macromastia). background-color: #cc0066; margin-top: 38px; 2003;111(2):688-694. 2001;108(6):1591-1599. The only criterion that the authors found supportable wasa requirementfor a pre-operative mammogram for women aged 40 years and older. Insurers have commonly used the amount of breast tissue to be removed as a criterion for evaluating the medical necessity of breast reduction surgery. Reduction mammoplasty specimens revealed abnormal findings in 68 (21.5 %) patients. Fan L, Yang X, Zhang Y, Jiang J. Endoscopic subcutaneous mastectomy for the treatment of gynecomastia: A report of 65 cases. 1998;49:215-234. Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna . Other just require 500 grams no matter what your height and weight. Choban PS, Heckler R, Burge JC, Flancbaum L. Increased incidence of nosocomial infections in obese surgical patients. Long-term functional results after reduction mammoplasty. Fagerlund A, Lewin R, Rufolo G, et al. Obstet Gynecol Clin North Am. Abnormal histopathological findings were more frequent in patients with reduction mammoplasty performed prior to oncological treatment (p < 0.001), and in patients with immediate reconstruction (p = 0.0064). Li CC, Fu JP, Chang SC, et al. The surgeon estimates that at least the following amounts (in grams) of breast tissue, not fatty tissue, will be removed from each breast, based on the member's body surface area (BSA) calculated using theMosteller formula. OL OL LI { Plast Reconstr Surg. Grooving where the bra straps sit on the shoulder. Cambridge, UK: Oxbridge Solutions, Ltd.; 2003. A study by Glatt et al (1999) was a retrospective analysis of responses to questionnaires sent to patients who underwent reduction mammoplasty regarding physical symptoms and body image. The authors concluded that the vacuum-assisted breast biopsy system could be used as a feasible and minimally invasive approach for the treatment of gynecomastia. Breast Reduction Surgery | Johns Hopkins Medicine Yao and co-workers (2019) described an innovative method for the operative treatment of gynecomastia -- vacuum-assisted minimally invasive mastectomy. For individuals who received radiation treatment to the chest . .arrowPurpleSmall, a:hover.arrowPurpleSmall { the nipple-areola complex can be elevated by de-epithelialization rather than recreating or developing a new pedicle; breast tissue is removed where it is in excess, usually inferiorly and laterally; the resection is complemented with liposuction to elevate the bottomed-out inframammary fold; and. Anzarut A, Guenther CR, Edwards DC, Tsuyuki RT. J Plast Reconstr Aesthet Surg. Furthermore, you must test negative for breast cancer on a mammogram a maximum of two years before your surgery if you are 50 or older. 2017;35:157-161. Plast Reconstr Surg. of the following criteria must be met: background-color: #663399; Gynecomastia may be drug-induced. Prostate Cancer Prostatic Dis. Asian J Surg. In Type I (idiopathic) gynecomastia, the adolescent presents with a tender, firm mass beneath the areola. Nelson JA, Fischer JP, Chung CU, et al Obesity and early complications following reduction mammaplasty: An analysis of 4545 patients from the 2005-2011 NSQIP datasets. A population-level analysis of bilateral breast reduction: does age affect early complications? and areola. If breast growth has been completed, breast reduction surgery is an option. Marshall and Tanner (1969)shows that the final stage of breast maturityoccurs about age 15 on average, but there is wide variation. What can I do if my insurance denies coverage for breast reduction? Follow-up ranged from 2 months to 3 years. Mistry RM, MacLennan SE, Hall-Findlay EJ. Links to various non-Aetna sites are provided for your convenience only. border: none; The authors (Nguyen et al, 2004) argue, based primarily on the results of the ASPS-funded BRAVO study (described below), that (with a single exception) no objective criteria for breast reduction surgery are supportable, including criteria based upon the presence of particular signs or symptoms, requirements based upon breast size or the amount of breast tissue removed, any minimum age limitations, any limitation based upon maximum body weight, requirements for a trial of conservative therapy, or the exclusion of certain procedures (liposuction). PDF 0185 Breast Reconstructive Surgery (1) - Aetna Within this study population, 54.4% of patients were obese (BMI > 30 kg/m2), of which 1308 (28.8%) were Class I (BMI = 30-34.9 kg/m2), 686 (15.1%) were Class II (BMI = 35-39.9 kg/m2), and 439 (9.7%) were Class III (BMI > 40 kg/m2). Sabistons Textbook of Surgery (Burns & Blackwell, 2008)states that breast size should be stable for one year: There is no set lower age limit but, for the adolescent with breast hypertrophy, reduction is deferred until the breasts have stopped growing and are stable in size for at least 12 months before surgery.. A total of 3 RCTs were identified and included in the review out of 190 studies that were initially screened; all evaluated wound drainage after breast reduction surgery. Moreover, these researchers stated that further studies are needed within the common gynecomastia population managed by plastic surgeons to examine the clinical and economical utility of this intervention before a recommendation for its ubiquitous adoption in plastic surgery can be made to continue improving outcomes for high-risk gynecomastia patients. The Breast: Comprehensive Management of Benign and Malignant Diseases. Is there a rationale behind pharmacotherapy in idiopathic gynecomastia? Schnur PL, Hoehn JG, Ilstrup DM, et al. Drains were used significantly less by surgeons performing greater than or equal to 20 BBRs (p = 0.02). Schnur subsequently refuted the validity of the Schnursliding scaleand stated that thescale should no longer be used as a criterion for the determination of insurance coverage for breast reduction surgery (Nguyen et al, 1999). The authors concluded that this study was the largest to-date examining the role of tamoxifen in idiopathic gynecomastia, and these findings showed approximately 9 in every 10 men treated with tamoxifen therapy had successful resolution of their symptoms. These investigators support its use for idiopathic gynecomastia in eligible men following the careful discussion of its risks and benefits.

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